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40a 530 <br /> SGL. SK 5!a T P# � 1111111111111111111111111111111111111 <br /> 0062864703 KS <br /> Please print or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMS No.2050-0039 <br /> 1.Generator ID Number 2 P 1 of cy 4.Manifest Track! Number <br /> UNIFORM HAZARDOUS rAL>d004233f,S � �� �"-i� 0062fi 4?0 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailir�Address Generators Site Address(if different than mailing address) <br /> Rail Tpraina,t Services <br /> 1000 E Roth Rd <br /> FRENCH CAMP CA 95231-0000 <br /> Generators Phone: 209-546--7279 <br /> 6.`",f" -'MVWSYSTEMS INC U.S.EPA ID Number Tx ROOOOS] 05 <br /> 7.Trans iter 2 Com n Name U.S.EPA ID Number <br /> CLAN HAIR.OPS ENVIRONMENTAL SVC INC. MAD0.39 22250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS SAN JOSE U.S.EPA ID Number <br /> 1021 BERRYESSA ROAD <br /> SAN JOSE , CA 9513 <br /> CAD059494310 <br /> +08-441-0962 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1.NON RCRA HAZARDOUS WASTE SOLIDS DM O P 2c3 <br /> o .DESRIS, PETROLEUM HYDROCARBON91 <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:S J 75335254 RA24640 <br /> 24 HR EMERGENCY #1-800-468-1760 (SK f TFI) ��'D -✓� � ��[f <br /> PLiTH A5 "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CRIERS AS C!"SSARY <br /> 15. GENERATOR'S16FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and a8tmately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Export ,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Conse <br /> I certify, hat the waste ' ' ' tion sta t identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(f I a small quantify generator)is true. <br /> Generators! rors Prin me Signature Month Day Year <br /> +� <br /> J 16,Intemabo I Shipments <br /> F ❑import to U.S. ❑Export from U. ntrylexit: <br /> Z Transporter signature(for exports only): Data ving U.S.: <br /> W 17.Transporter Adrnowfedgment of Receipt of Materials <br /> Ej Transporter 1 P' tedrryped Name SignafW Month Day Year <br /> IL f '- r7 <br /> U)Q Trans r Printedlfyped Name Signatu 44 1 , Month Day Year <br /> 4A <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> LL Facility's Phone, <br /> LL, 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> W19.Hazardous Waste Report Manage Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. T <br /> 4. <br /> - A I <br /> 20.Designated F liOwner or Operator, cation of ' of hazardous ma ' covered by the manifest ex as noted" <br /> Print ped Signaiu Month Day Year <br /> r <br /> EMF rrn 87p0-2 (R v.3-0r Pr�vious editions are o <br /> I S�0i E�FF,���4c�AF�.S � EE-1-N—E;,FPeLITY ESTI NATION STATE (IF REQUIRED) <br />